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EM + clinical psychology side hustle?

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  • EM + clinical psychology side hustle?

    Hello!

    I know a clinical psychologist who is looking for some extra help with her practice. She currently has a physician who helps her with prescriptions, but both of their practices are getting so busy, that she wants to bring someone else in. Now, I'm an emergency medicine doctor, so I'm not 100% sure I can do this. I have a meeting with her tomorrow to discuss details, but wanted to see if this was an obvious, hard no you are not allowed to do that, before we went too far.

    I imagine I would have to establish some kind of patient relationship, likely with virtual visits. Some other thoughts I had were that maybe I only prescribe on an emergency basis, or to people who have stable prescriptions and just need a refill.

    Interested to hear any thoughts.

  • #2
    There's a reason you're an EM doc and not a psychiatrist. I don't see a reason why you technically couldn't but it's got bad idea written all over it.

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    • #3
      absolutely do not do this
      a bad outcome in this situation would be indefensible

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      • #4
        Maybe if you were FP. Otherwise out of scope of practice. I assume you don't routinely hand out 30 days of psych meds in the ER
        if you don't believe me ask your malpractice insurer

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        • #5
          Seriously? That's like me as a psychiatrist doing a side hustle as an ER doc. Totally out of scope of practice. If you think you can rely on the psychologist to diagnose and you can just prescribe, you are sadly mistaken. Psychologists misdiagnose more often than I'd like to think about and you'd be on the hook. It's concerning to me that you even think this might be fine.

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          • #6
            On thing I've learned in the years since I got my medical license is that you can practice any medicine you like no matter what your speciality is, as long as someone will hire you and/or patients will pay you. What you can't do is defend yourself in court if something goes wrong. Up to you as to whether that matters to you.

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            • #7
              Originally posted by dmndangel View Post
              I have a meeting with her tomorrow to discuss details,
              So how did the meeting go?

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              • #8
                You would need to have a background in psychiatry, some special training, or significant clinical experience to safely and appropriately manage the psych meds for a variety of psychiatric conditions with confidence. You would be doing the psychologist, the patients, and yourself a disservice if you decide to proceed.

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                • #9
                  I would not take this as a job. However I felt very comfortable prescribing a limited number of antidepressants and antianxiety meds. Getting patients seen by psychiatrists can be hard. I think you do close follow up and refer if they do not improve rapidly. I would never treat bipolar or schizophrenia.

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                  • #10
                    I'm a psychiatrist.

                    This is a very bad idea.

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                    • #11
                      I occasionally write a 30 day prescription (Celexa usually or maybe a refill of something they're already on), but I still wouldn't do this. This isn't a side gig, this is practicing another specialty.
                      Helping those who wear the white coat get a fair shake on Wall Street since 2011

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                      • #12
                        You could probably make a case for some addiction medicine with the psych overlap. EM is uniquely positioned to get people off substances cleanly with some therapy and support on the other side from your colleague. Ketamine infusions etc also within our scope of practice as we are very familiar with the medication and administering it safely. However long term management of depression and particularly bipolar, schizophrenia etc make me very nervous. Some EM docs have transitioned well in my area to concierge primary care and with enough reading I think that's easily defensible but this is pushing the limits based on first description.

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